特殊类型颈动脉海绵窦瘘的血管内栓塞治疗

目的　探讨特殊类型颈动脉海绵窦瘘的血管内栓塞治疗的可行性及其价值。方法 :2 8例有外伤史的患者 ,采用Seldinger技术送入导管行全脑血管造影 ,观察侧支循环情况后 ,进行血管内栓塞治疗。结果 :双侧颈动脉海绵窦瘘 6例 ;单侧者为小瘘口 4例、多发瘘口者 2例 ,瘘口部合并骨折片者 11例 ,合并创伤性动脉瘤者 3例 ;栓塞后出现NPPB者 2例。血管内栓塞治疗中 ,闭塞瘘口保持颈内动脉通畅者 9例 ,闭塞瘘口同时闭塞颈内动脉者 19例。结论 :对于特殊类型颈动脉海绵窦瘘行血管内栓塞治疗是安全、有效的 ,应为首选的方法。对于不同病例应采取特例特办的原则 ,方可取得良好的治疗效果。     

创伤性颈动脉海绵窦瘘血管内治疗的护理

目的:探讨创伤性颈动脉海绵窦瘘(TCCF)血管内治疗中的护理。方法:本组37例TCCF,术前进行心理护理、侧支循环训练和眼部护理,术中配合医生操作,术后观察生命体征,早期发现过度灌注综合征。结果:37例均成功进行了血管内栓塞治疗,症状和体征消失。3例术后发生过度灌注综合征,由于发现及时均得到了有效缓解。结论:围手术期护理对于TCCF血管内治疗有重要意义。     

The cerebral circulation in cases of carotid cavernous fistula

Summary Ten patients with carotid cavernous fistula (CCF) were reviewed. Single photon emission computed tomography (SPECT) for regional cerebral blood flow (rCBF) study was performed in six patients with fast flow shunt. Five of these six patients with fast flow shunt angiographically demonstrated cortical venous drainage, and two of these patients suffered intracerebral hemorrhage. The rCBF decreased in the region demonstrating the cortical venous drainage in five patients, and in one patient the angiography demonstrated arterial steal and the rCBF decreased in a part of the ipsilateral cerebral hemisphere. SPECT proved to be useful in assessing the cerebral circulation in cases of CCF.     

颈动脉海绵窦瘘的临床及影像学诊断

目的:分析颈动脉海绵窦瘘的临床及影像学特征。方法:回顾性分析25例具有完整临床资料的颈动脉海绵窦瘘患者的临床、全脑血管造影及10例螺旋CT表现。结果:临床表现为颅内杂音、不同程度的搏动性突眼、眼球运动障碍,视力减退或伴有复视、结膜水肿和充血。CT表现为眼球突出、眼上静脉增粗、海绵窦扩大、密度增高、眼球边缘模糊、眼睑肿胀。全脑血管造影表现为对比剂自颈内动脉或颈外动脉分支溢入海绵窦,形成一团浓密的不规则阴影,海绵窦及眼静脉等早期显影而颈内动脉床突上段和大脑前、中动脉不易充盈,并且可观察到瘘口位置、大小及侧支循环情况。结论:根据颈动脉海绵窦瘘的临床表现和CT征象可以诊断颈动脉海绵窦瘘,脑血管造影是其诊断的金标准,并为进一步选择治疗方案提供依据。     

Localization of carotid cavernous fistula using digital subtraction angiography

Digital subtraction angiography (DSA), with its rapid imaging rate (30 video frames per second) and immediately available subtraction images, provides excellent vascular detail in localization of the exact site of internal carotid-cavernous fistula. In a patient with two fistulas, we successfully used DSA to determine the sites of fistula and accurately positioned detachable balloons to occlude them.     

颈动脉海绵窦瘘的MRI诊断(附12例报告)

目的分析颈动脉海绵窦瘘(CCF)的MRI表现及诊断价值。方法搜集近年有完整临床资料的CCF12例进行MRI表现的回顾性分析。其中男8例，女4例；外伤性CCF11例，自发性1例，均由DSA造影证实。结果MRI主要表现为：(1)眼球突出11例；(2)海绵窦扩大12例；(3)眼上静脉扩张、迂曲11例，蝶顶窦和大脑中、浅静脉扩张2例，岩上窦和岩下窦扩张2例，眼下静脉和眼睑静脉扩张1例；(4)眼外肌增粗3例；(5)脑萎缩3例，脑水肿和脑出血2例。结论MR检查是一种无创伤的诊断CCF的方法，具有准确、方便、特异性高等优势，能明确病变部位及程度，但应进行必要的鉴别诊断。     

Transvenous embolization of a direct carotid cavernous fistula through the pterygoid plexus

Closure of a direct carotid cavernous fistula with detachable coils by transpterygoid venous approach to the cavernous sinus is an alternative technique that may be applied in cases in which other techniques offer increased risk or in which other techniques have failed. In this case report, we present the details of the management of a direct carotid cavernous fistula by this method.     

Balloon reconstructive technique for the treatment of a carotid cavernous fistula.

Endovascular treatment of carotid cavernous fistulas (CCFs) presents many technical difficulties and hazards, some unique to each patient. This report details some of the difficulties encountered in the treatment of a 63-year-old patient with a CCF and an ipsilateral internal carotid artery dissection. After failure of conventional techniques using a detachable balloon, complete closure of the CCF was achieved by transvenous coil embolization while the arterial lumen was protected by a nondetachable balloon catheter.     

闭塞颈内动脉治疗颈动脉海绵窦瘘的中长期疗效随访

目的 探讨治疗性闭塞颈内动脉对于颈动脉海绵窦瘘(CCF)患者的中长期疗效及影响.方法 回顾2001年9月至2012年2月收治的CCF患者的临床资料及随访资料,分析其临床症状特点,统计闭塞颈内动脉的比例.期间收治CCF患者共96例,单纯型CCF 81例、复杂型CCF15例.单纯型CCF患者中32例(39.5％)术中实施了颈内动脉闭塞术(闭塞ICA组),其余64例患者保全ICA(保全ICA组).通过电话问卷和门诊复查的方式,在术后2周,3、6、12、36个月时进行随访.评价遗留症状对患者生活质量的影响,探讨治疗性闭塞颈内动脉对于CCF患者的中长期疗效.结果 实施颈内动脉闭塞术的患者,术后2周3例尚遗留视力损害,其余患者眼部体征消失、改良Rankin量表(mRS评分)≤2分.术后12个月闭塞ICA组生存30例,随访头痛评分(HIT-6)高于50分的6例(20％);保全ICA组生存54例,高于50分的5例(9％),2组差异无统计学意义(x2=1.955,P=0.162).术后36个月随访生存质量量表评分(SF-36)显示在躯体疼痛,总体健康和活力3个维度,闭塞ICA组的平均得分分别为(73.6±18.4)、(55.2±18.0)、(49.1±18.7)分,保全ICA组分别为(78.0±16.1)、(59.3±16.5)、(52.8±19.5)分;2组相比,躯体疼痛(t=2.403,P=0.023),总体健康(t =2.043,P=0.040),活力(t=2.019,P=0.046)评分差异均有统计学意义.CTA未发现继发的颅内血管病变.结论 闭塞海绵窦段颈内动脉对于CCF的治疗可行、有效,但有可能对患者的长期生存质量产生负面影响.     

可脱球囊栓塞术在海绵窦瘘治疗中的应用 (附 2 7例报告 )

目的　研究微导管可脱球囊技术治疗海绵窦瘘的临床意义。方法 :2 6例外伤性颈内动脉海绵窦瘘 (TCCF)患者和 1例大脑前动脉 (A1段 )动脉瘤破裂合并海绵窦瘘患者采用微导管可脱球囊技术进行栓塞治疗 ,以经颅多普勒 (TCD)进行复查 ,所有患者均随访 6月以上。结果 :2 2例CCF患者均成功栓塞瘘口并保持颈内动脉通畅 ,其中 2 0例为一次栓塞成功 ,2例因球囊过早泄漏而行 2次栓塞治疗。对 1例A1段动脉瘤破裂合并海绵窦瘘患者成功施行了双球囊动脉瘤颈孤立术。 4例行颈内动脉闭塞术。本组病例未发生严重并发症。结论 :微导管可脱球囊技术是对海绵窦瘘的一种微创、安全、有效的治疗方法。     

外伤性颈动脉海绵窦瘘的血管内栓塞治疗

目的 探讨外伤性颈动脉海绵窦瘘的血管内栓塞的治疗效果。方法 对50例颈动脉海绵窦瘘中的45例采用可脱性球囊栓塞,另5例采用铂金微弹簧圈栓塞。结果 本组均治愈,45例随访1-10年无复发。5例铂金微弹簧圈栓塞病例中,1例发生轻度脑干缺血,留有轻度肢体偏瘫,轻度吞咽困难,术后3个月逐渐恢复。其余无神经系统功能障碍。结论 血管内栓塞治疗外伤性颈动脉海绵窦瘘具有微创、安全、效果可靠等优点,可脱性球囊栓塞是治疗本病的有效方法。     

Transarterial embolization of a direct carotid cavernous fistula with Guglielmi detachable coils.

Four patients underwent transarterial embolization of a carotid-cavernous fistula with Guglielmi detachable coils; in three cases as the initial form of treatment and in one case after treatment via transarterial balloon embolization failed. The fistulas were 2 to 3 mm in diameter on pretreatment angiograms. Complete obliteration was achieved in two patients; in the other two, minimal residual flow remained immediately after embolization but disappeared by follow-up angiography. One to four coils were used to occlude the fistulas. The internal carotid artery remained patent in all patients, and there were no complications.     

Direct carotid cavernous fistula in infancy: presentation and treatment

An 11-month-old female patient presented with symptoms of orbital venous congestion. A CT scan showed enlarged superior ophthalmic vein and cavernous sinus on the symptomatic side. Catheter angiography confirmed a direct carotid-cavernous fistula with intra- and extracranial venous drainage. Successful coil embolization of the fistula was performed with resolution of the infant's symptoms and return of previously elevated intraocular pressures to normal. To our knowledge, no cases of carotid cavernous fistulas in infancy have been previously reported.     

急症血管内栓塞治疗外伤性颈内动脉海绵窦瘘

目的探讨血管内栓塞治疗外伤性颈内动脉海绵窦瘘（TCCF）在紧急情况下的应用价值。方法TCCF297例，急诊血管内栓塞治疗36例中，其中严重鼻出血22例，大量流入皮质静脉9例，颅内出血3例，视力恶化3例，肢体功能障碍2例。全部病例采用可脱性球囊栓塞瘘口或闭塞颈内动脉，5例患者用可脱性球囊闭塞瘘口及颈内动脉后，采用弹簧圈保护性闭塞颈内动脉。结果36例中，1次性栓塞瘘口并颈内动脉通畅19例；1次性栓塞瘘口部及颈内动脉者17例。22例鼻出血者未再出血；3例颅内出血未再发生出血；3例视力恶化者2例视力恢复，1例明显提高；2例肢体功能障碍明显改善。结论血管内栓塞治疗TCCF是首选的治疗方法，急诊栓塞治疗对一些危及生命或可能导致严重后遗症的TCCF是必要、安全和有效的。